California Department of State Hospitals, Sacramento, California, USA.
Department of Criminology, California State University, Fresno, California, USA.
CNS Spectr. 2020 Oct;25(5):734-742. doi: 10.1017/S1092852920001273. Epub 2020 Jun 9.
We investigated clinical and demographic variables to better understand their relationship to hospital length of stay for patients involuntarily committed to California state psychiatric hospitals under the state's incompetent to stand trial (IST) statutes. Additionally, we determined the most important variables in the model that influenced patient length of stay.
We retrospectively studied all patients admitted as IST to California state psychiatric hospitals during the period January 1, 2010 through June 30, 2018 (N = 20 041). Primary diagnosis, total number of violent acts while hospitalized, age at admission, treating hospital, level of functioning at admission, ethnicity, sex, and having had a previous state hospital admission were evaluated using a parametric survival model.
The analysis showed that the most important variables related to length of stay were (1) diagnosis, (2) number of violent acts while hospitalized, and (3) age of admission. Specifically, longer length of stay was associated with (1) having a diagnosis of schizophrenia or neurocognitive disorder, (2) one or more violent acts, and (3) older age at admission. The other variables studied were also statistically significant, but not as influential in the model.
We found significant relations between length of stay and the variables studied, with the most important variables being (1) diagnosis, (2) number of physically violent acts, and (3) age at admission. These findings emphasize the need for treatments to target cognitive issues in the seriously mentally ill as well as treatment of violence and early identification of violence risk factors.
我们研究了临床和人口统计学变量，以更好地了解它们与根据州“无能力应诉”法规被强制送加州州立精神病院的患者住院时间的关系。此外，我们确定了影响患者住院时间的模型中最重要的变量。
我们回顾性研究了 2010 年 1 月 1 日至 2018 年 6 月 30 日期间被强制送加州州立精神病院的所有 IST 患者（n = 20041）。使用参数生存模型评估了主要诊断、住院期间发生的暴力行为总数、入院时年龄、治疗医院、入院时的功能水平、种族、性别以及是否有以前的州立医院入院史。
分析表明，与住院时间相关的最重要变量是（1）诊断，（2）住院期间发生的暴力行为次数，以及（3）入院年龄。具体来说，较长的住院时间与（1）患有精神分裂症或神经认知障碍，（2）一次或多次暴力行为，以及（3）入院时年龄较大有关。研究中的其他变量也具有统计学意义，但在模型中没有那么重要。
我们发现住院时间与所研究的变量之间存在显著关系，最重要的变量是（1）诊断，（2）身体暴力行为次数，以及（3）入院年龄。这些发现强调了需要针对严重精神疾病患者的认知问题进行治疗，以及治疗暴力行为和早期识别暴力风险因素。
